ccrmc - Pediatric Obesity

Diagnosis of Obesity

Start evaluating BMI at 2 years of age. Monitor blood pressure percentile of school age children.
Overweight = BMI for age 85-94%
Obese = BMI for age >95%

Guidelines for Prevention, Diagnosis, Management, Comorbidities, Labs, and Referrals
Prevention

Infants- Encourage exclusive breastfeeding until 6 months, continue breastfeeding to one year if possible. See wikipage for breastfeeding information: http://ccrmc.wikispaces.com/Breastfeeding+Information
Toddlers - "5-2-1-0"
- 5 Fruits and Vegetables a day
- 2 or less Hours of Screen Time
- 1 Hour of Active Play
- 0 Sugary drinks (juice, Capri-Sun, soda, Nesquick, Gatorade, horchata)
School Age - See above. Also ask about fast food, junk food. Assess for disordered eating, body image, comorbidities of obesity
All ages - Document family history of obesity, diabetes, hypertension, and hyperlipidemia.

Treatment

Appropriate to follow-up every 3-6 months until the child's velocity of weight gain has slowed.
For overweight children, the goal is to maintain the same BMI over months to years.
Gradual weight loss is the goal for children 2-5 years old with a BMI > 99% and for children > 5 years old with a BMI > 95%.

Co-morbidities of Obesity - Labs and Referrals

Labs - consider fasting glucose, fasting lipids, AST/ALT, BUN, Cr in:
- BMI > 85% who are:
- 10 years and older with a positive family history for obesity, diabetes, or hyperlipidemia
- Hispanic/African American
- Signs of insulin resistance such acanthosis nigricans
Referral is indicated for:
- Persistent Hypertension (BP > 95 Percentile + 5 mmHg x 3) - CHO nephrology or cardiology
- Glucose Intolerance (Fasting glucose > 125 x 2) - CPMC Endocrinology
- Elevated AST/ALT (> 60 after efforts to lose weight) - CHO GI
- Dyslipidemia (total fasting cholesterol > 190) - CHO cardiology or Healthy Hearts Clinic

Patient Education - Patient Handouts and Options Counseling Tools

La Clínica Pediatric Patient Information Handouts - English and Spanish, Healthy Eating and Active Lifestyle, Patient Friendly
MyPlate Website - USDA website with MyPlate graphics, patient handouts, recipes
Chop Chop - Healthy Recipes Website and Magazine
Champions for Change
Kidshealth.org - English and Spanish, Variety of Topics, Patient Friendly
Kaiser Options Tools - Pediatric Weight Management, Physical Activity, Healthy Eating
Turn off TV Handout - English, Spanish
Have Fun and Be Healthy Bicycling Fruits Handout - English, Spanish

Community Resources for Healthy Eating and Physical Activity

Referrals for Prevention and Treatment of Pediatric Obesity

Infants and Breastfeeding - PHN breastfeeding referral, Lactation clinic referral, WIC, or Lactation consultant warmline 925-313-8986
Ages 2-5 - nutrition classes at First Five, see locations and schedules at different sites in the county at: First Five
Ages 2-11, BMI% for age > 95%ile - CCHP Pediatric Obesity Disease Management Program: Families are contacted quarterly and sent information about healthy lifestyles. CCHP will also give providers feedback and assist with referrals every 3-6 months. To refer in ccLink, type "pediatric obesity" in meds and orders field.
Ages 5-11 - WeCan - a 5 session series of group visits. To refer in ccLink, type "pediatric obesity" in meds and orders field.
Ages 2-18 with medical complications of obesity - specialty clinic at Children's Hospital Oakland - Healthy Hearts Preventive Cardiology Clinic at Children's Hospital Oakland - To refer in ccLink, type "CHO" in meds and orders field to generate prior auth. Fill out CHO forms and send to care coordinator/PHN.
Ages 12-18 in East County - Kaiser Nutrition Class, free, held quarterly in Antioch.
All ages - Dietitians can see patients up to 4 times a year, tailoring counseling to individual families.

Information and CME for Providers